Kathryn Gilliam, RDH, BA, is passionate about the oral-systemic health link. The founder of Periolinks has spent her career empowering dental hygienists to move beyond prophylactic cleanings and become oral health care providers. Gilliam believes that a well-trained hygiene team doesn’t just improve production and attract patients – it also saves lives.
Currently, much of Gilliam’s work focuses on early cancer detection, the Bale-Doneen method for cardiovascular disease prevention, and helping practices transition from providers of general dentistry to dental wellness centers. In Gilliam’s experience, when a practice embraces the total health model, their production increases, their patients become healthier, and they create a loyal patient base who are enthusiastic about their care and who act as brand ambassadors in the larger community.
Gilliam took the time to answer a few of our questions about her focus on wellness, her vision for dental hygienists, and the future of dental hygiene.
Hygienists are on the front lines of patient care and spend more time with patients than the dentist does. What’s the number one thing they should be doing to improve patient health and wellness?
The number one thing that dental hygienists should be doing to improve patient health and wellness is to educate their patients about the link between oral health and overall health. When we explain the risk factors, we empower our patients to take charge of their own health and reduce their risk of many inflammation-based systemic diseases.
The second most important thing that dental hygienists should be doing to improve patient health and wellness is to perform a thorough head and neck cancer screening examination for every patient at every appointment. HPV-related head and neck cancers are on the rise, and many experts believe we will see this disease reach epidemic proportions in the next decade. Early detection, before the cancer has become invasive or metastasized, can make an enormous difference between a favorable outlook and a poor prognosis. By screening every patient every time, you increase the likelihood of finding abnormalities at an early stage, thereby reducing your patient’s risk of devastating health effects.
Which patients are most at risk for oral cancers? How do you explain their risk factors to them in a sensitive and helpful manner? How do you explain the importance of oral cancer screenings to your lower-risk patients?
The people most at risk for oral cancer are actually people with periodontal disease. Most people, even dental professionals, don’t know that periodontal disease is a greater risk for head and neck cancer than smoking.
People who are positive for the human papilloma virus (HPV) are also at increased risk for oral cancer. Typically, these people are young, making a cancer diagnosis even more devastating.
The traditional risk category for oral cancer that most are aware of is people who use tobacco and alcohol; however the numbers of people in this category are remaining stable, not increasing like the numbers of those who have HPV-related oral cancer.
I explain cancer risk the same way to all of my patients, regardless of their perceived risk. The reason for this is that most people who have HPV don’t actually know they have the virus. They are asymptomatic, so we don’t really know their risk for HPV-related head and neck cancer. Also, one in four people who get head and neck cancers have none of the known risk factors, so it’s impossible to “rule out” anyone. We must remain cautious and screen everyone.
Additionally, risk for cancer changes over time for various reasons, so I don’t want to give anyone the impression that they are safe or immune if they happen to be deemed low risk today. It’s important for everyone to remain vigilant, to be screened at every dental appointment, to be self-aware, and to notice and follow up on any changes in the mouth, throat, or neck that don’t disappear in two weeks.
I express the importance of oral cancer screening to all of my patients by telling them that rates of oral cancer are on the rise, while rates of all other cancers are decreasing. I also say, “We want to make sure that if there are any changes in your mouth, we find them at the earliest possible moment. That’s why we screen every patient at every appointment. When cancers are caught early, we have the best chance for a positive outcome.”
How does the oral-systemic health link change as a person ages? Are their special signs to watch for in patients over 40? Over 55? Over 65?
In general, as people age, the immune system doesn’t respond as well to challenges such as bacterial infection and chronic inflammation. As a result, older people may be more susceptible to infections and they may heal more slowly than they did when they were younger. This makes it even more important to keep chronic systemic diseases such as periodontal disease and diabetes under control.
The oral bacterial biofilm can be composed of particularly pathogenic bacteria such as Porphyromonas gingivalis that impair the person’s immune response, so the ability to fight off periodontal infection is decreased. If you add that to increasing plaque buildup in the walls of the arteries, for example, risk for heart attack or stroke is increased.
In the case of cardiovascular disease, the number one killer of men and women, age is a factor. I encourage all adult patients to have a simple, painless, inexpensive ultrasound examination (Carotid Intima Media Thickness Test or CIMT) to check the health of the arteries. This information can help determine risk of heart attack or stroke. With the knowledge from the CIMT, patients can make proactive changes in their diet, exercise, and self care habits.
I would also encourage an oral bacterial DNA test to identify the presence of pathogenic oral bacteria that could be contributing to chronic systemic inflammation in mature patients with periodontal disease. By targeting treatment to eliminate those pathogens, and improve periodontal health, we can significantly reduce risk of systemic diseases such as cardiovascular disease, Alzheimer’s disease, diabetes, rheumatoid arthritis and some cancers in our mature patients.
Have you seen any dental practices that do an especially good job promoting the health and wellness of their patients? What do they do that other practices should emulate?
I have seen a few practices that do a great job promoting the health and wellness of their patients. They use a multi-faceted approach to increase awareness of the oral-systemic link. They post articles on their websites and Facebook pages, they hang posters in their treatment rooms, they run informational videos in their reception areas, and they include brochures on the oral-systemic health link with their billing statements, and other correspondence.
I see those practices perform head and neck cancer screenings with fluorescence devices at no extra charge for every patient at every exam, and they explain the importance of cancer screenings to the patients each time. They invite patients to bring their family members and friends for a free screening and they participate in community events, providing free cancer screenings. They participate in local health fairs, distributing information and providing simple tests, such as an oral pH screening.
These practices never fail to talk to their patients about their overall health in relation to their oral health. They ask for recent blood glucose numbers, they monitor blood pressure and encourage patients to see their physician if it’s not in optimal range. They refer their patients who show signs of airway obstruction for sleep studies and they make sleep apnea devices for those who are unable to tolerate a CPAP machine. They provide alternative practitioners contact information and make referrals when the patients have a less than up-to-date physician.
Practices that do a good job promoting the health and wellness of their patients use the latest technology available, including bacterial DNA testing, microscopes in the office, and airway devices. These dental teams establish good working relationships with area physicians and co-manage patient care with them. Some of these practices have a physician, nurse practitioner, or physician’s assistant working in their offices to make co-management even easier. When this is the case, they are able to order blood tests that are typically out of the standard practice of dentists, but which are very beneficial for monitoring the systemic inflammation and other important signs of overall health.
Dental practices on the forefront of health and wellness also provide information and support for improving their patients’ lifestyle habits such as nutrition counseling and tobacco cessation programs.
These leading practitioners speak to their patients in a way that shows they are knowledgeable healthcare professionals, giving their patients the confidence that they are in very good hands and can trust the treatment recommendations that they are given.
Why are you so passionate about the oral-systemic health link?
The knowledge that we can positively affect the whole health of our patients, not just their teeth, absolutely transformed my clinical practice.
For so long, few people made the connection between the mouth and the body. Then those on the forefront of scientific thought postulated theories about the logical connection, but the majority of dental professionals scoffed. Now we have scientific proof to back up the theories and it’s time to put the science of the oral-systemic connection into clinical practice. It’s an enormous opportunity and it will revolutionize healthcare. We’re not just saving teeth, we’re saving lives!
What would you like to see every dental practice in America do to promote patient health and wellness?
I would like to see every dental practice across the country, and around the world, perform a head and neck cancer screening for every patient at every appointment. For me, this is the minimum standard of care that should be expected by every dental patient.
Beyond that, I would love to see every dental practice educate patients about the connection between oral health and systemic health. When patients know about the link between bleeding gums and chronic inflammation they can be proactive with their lifestyle choices and in their healthcare.
A growing number of dental patients lack medical insurance. Are there things that dentists can do in-office to help improve the total body health of this group?
Care doesn’t have to be expensive. In the dental office, we can educate our patients about nutrition, hydration, balanced pH, exercise, and smoking cessation along with oral self-care instructions. All of these lifestyle habits can greatly improve total body health.
Dental offices could also do complimentary head and neck cancer screenings as part of the routine periodic and comprehensive examinations to remove any financial barrier to this lifesaving assessment.
Dentists could offer in-office financing to patients to help patients pay for laboratory testing, periodontal and restorative treatment, and consultations with a nurse practitioner in the dental office.
For more information on Gilliam’s work, or to arrange for coaching and continuing education for your team, visit her site at http://periolinks.com/contact/.